Demographic and Experiential Correlates of Public Attitudes Towards Cell‐Free Fetal DNA Screening

Abstract

This study seeks to inform clinical application of cell-free fetal DNA (cffDNA) screening as a novel method for prenatal trisomy detection by investigating public attitudes towards this technology and demographic and experiential characteristics related to these attitudes. Two versions of a 25-item survey assessing interest in cffDNA and existing first-trimester combined screening for either trisomy 13 and 18 or trisomy 21 were distributed among 3,164 members of the United States public. Logistic regression was performed to determine variables predictive of interest in screening options. Approximately 47% of respondents expressed an interest in cffDNA screening for trisomy 13, 18, and 21, with a majority interested in cffDNA screening as a stand-alone technique. A significantly greater percent would consider termination of pregnancy following a diagnosis of trisomy 13 or 18 (52%) over one of trisomy 21 (44%). Willingness to consider abortion of an affected pregnancy was the strongest correlate to interest in both cffDNA and first-trimester combined screening, although markedly more respondents expressed an interest in some form of screening (69% and 71%, respectively) than would consider termination. Greater educational attainment, higher income, and insurance coverage predicted interest in cffDNA screening; stronger religious identification also corresponded to decreased interest. Prior experience with disability and genetic testing was associated with increased interest in cffDNA screening. Several of these factors, in addition to advanced age and Asian race, were, in turn, predictive of respondents’ increased willingness to consider post-diagnosis termination of pregnancy. In conclusion, divergent attitudes towards cffDNA screening - and prenatal options more generally – appear correlated with individual socioeconomic and religious backgrounds and experiences with disability and genetic testing. Clinical implementation and counseling for novel prenatal technologies should take these diverse stakeholder values into consideration.

“Don't Want No Risk and Don't Want No Problems”: Public Understandings of the Risks and Benefits of Noninvasive Prenatal Testing in the United States

“…Additionally, the distributions of respondent age (lower) (χ 2 [5, N=3164]=166.340, p <0.001); household income (higher) (χ 2 [4, N=3164]=140.058, p <0.001); and educational attainment (higher) (χ 2 [4, N=3164]=469.694, p <0.001) were significantly different from those of the national population. Additional demographic information, such as experience with parenting or disability, and their correlates with testing recommendations, is reported elsewhere (Sayres et al 2014). …”

“…No statistically significant differences in the frequency of any of these codes were detected between responses to the trisomy 13/18 and trisomy 21 surveys. Because many respondents did not make a clear choice for or against NIPT (see Sayres et al 2014), and many reasons cited for respondents’ choices referred to prenatal testing generally rather than any particular technology, we have presented this qualitative analysis by code only, rather than by test recommendation. However, where relevant, we have noted the relationship between these themes and specific recommendations for or against NIPT.…”

“…Data and analysis from the quantitative portion of the study, including demographic predictors of testing choices, are published elsewhere (Allyse et al 2014; Sayres et al 2014). A broader team of bioethics scholars, including representatives from genetic counseling, maternal fetal medicine, and sociology, reviewed the survey’s text, including background materials, for readability and content.…”

Spanish‐ and English‐Speaking Pregnant Women's Views on cfDNA and Other Prenatal Screening: Practical and Ethical Reflections

“…Previous public opinion studies have found support in the United States (US) for the hypothetical availability of cfDNA screening (Allyse, Sayres, Goodspeed, Michie, & Cho, 2015; Allyse, Sayres, Goodspeed, & Cho, 2014), especially among populations with higher education and income levels (Sayres, Allyse, Goodspeed, & Cho, 2014). Farrell et al have conducted focus groups with small numbers of English-speaking pregnant women and also found general support, tempered with concerns around maintaining patient autonomy and clarity in results and their implications (Farrell, Mercer, Agatisa, Smith, & Philipson, 2014).…”

“…Another recent study in California found that 35% of Latinas with elevated risk pregnancies accepted the offer of cfDNA screening; women who scored higher on a knowledge scale (who were also more often fluent in English) more often accepted cfDNA screening, and most women who refused cfDNA also refused invasive testing (Farrell, Hawkins, Barragan, Hudgins, & Taylor, 2015). A recent national survey showed no significant difference in interest in cfDNA screening among those who identify as Latino/a and those who do not, although the survey was conducted only in English (Sayres et al, 2014). No studies to date have compared the in-depth views of Latina and non-Latina pregnant women on cfDNA screening.…”